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5-Azacitidine For Myelodysplasia Before Allogeneic Hematopoietic Cell Transplantation

5-Azacitidine For Myelodysplasia Before Allogeneic Hematopoietic Cell Transplantation. Field T et al. Bone Marrow Transplant 2009:[Epub ahead of print]. Introduction.

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5-Azacitidine For Myelodysplasia Before Allogeneic Hematopoietic Cell Transplantation

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  1. 5-Azacitidine For Myelodysplasia Before Allogeneic Hematopoietic Cell Transplantation Field T et al. Bone Marrow Transplant 2009:[Epubahead of print].

  2. Introduction • Patients with intermediate- or high-risk myelodysplastic syndrome(MDS) have a significant risk of relapse after hematopoietic cell transplantation (HCT). • The use of induction chemotherapy as pretransplant therapy can increase the risk of death or prevent proceeding to HCT because of associated toxicities. • 5-azacitidine therapy was shown to prolong overall survival and decrease the risk of progressing to acute myelogenous leukemia versus conventional care regimens in patients with intermediate-2 and high-risk MDS (Lancet Oncol 2009;10:223), providing an alternative strategy to inhibit disease progression in transplant-eligible patients. • Current study objectives (N = 54): • Assess the effect of pretransplant 5-azacitidine treatment on post- transplant outcomes using a retrospective analysis of the institutional experiences of patients with intermediate-2 and high-risk MDS. Source: Field et al. Bone Marrow Transplant 2009:[Epub ahead of print].

  3. Retrospective Analysis of Patients with Myelodysplasia Receiving 5-Azacitidine Therapy Pre-HCT Medical record review of consecutive patients (n=54) with MDS or chronic myelomonocytic leukemia who received allogeneic HCT between July 2004 and December 2007 at the H Lee Moffitt Cancer Center. Patients were assigned to two groups based on whether they had received 5-azacitidine therapy at any time prior to transplant. Patient characteristics were balanced in both study arms. All patients and donors received high-resolution molecular typingfor HLA-DRB1 and DQB1. All patients received the same conditioning regimen (Blood 2004:104:857). All patients received similar supportive care measures, including antiseizure and graft versus host disease (GVHD) prophylaxes. Source: Field et al. Bone Marrow Transplant 2009:[Epub ahead of print].

  4. Outcome Parameter1 With5-Azacitidine (n=30) Without5-Azacitidine (n=24) • Overall survival rate - 1 yr 47% 60% 41% 51% Cumulative incidence of GVHD • Grade 2-4 • Grade 3-4 79% 13% 71% 4% Cumulative incidence of relapse1 1 year 2 year 20% 31% 32% 36% Post-HCT Outcomes in Patients with Myelodysplasia with or withoutPre-HCT 5-Azacitidine Therapy 1p-values for all outcome parameters were nonsignificant Multivariate analyses demonstrated that pretransplant treatment with 5-azacitidine does not appear to be a significant predictor of relapse, nonrelapse mortality, overall and relapse-free survival, and grade 2-4 acute GVHD. Source: Field et al. Bone Marrow Transplant 2009:[Epub ahead of print].

  5. Summary and Conclusions • Treatment of patients with high-risk MDS with 5-azacitidine prior to HCT did not significantly affect rates of remission, relapse, acute and chronic GVHD, and survival after transplant. • A trend toward decreased early relapse in patients who had received 5-azacitidine was observed. • 5-azacitidine therapy may stabilize disease while patients await HCT. Source: Field et al. Bone Marrow Transplant 2009:[Epub ahead of print].

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